Coping with New Covid-19 Variants
Now that these new variants have entered our country, it is indeed necessary to take appropriate steps so that their spread can be contained in order to avoid possible spikes in cases, as have happened in other countries
On May 4, Kompas published a story titled Tiga Varian Baru SARS-CoV-2 Masuk ke Indonesia (Three new SARS-CoV-2 variants enter Indonesia), based on an official statement from the Health Ministry.
Then on May 5, the newspaper published Transmisi Lokal Varian Baru telah Terjadi (local transmission of new variants has occurred).
This is related to the recent discovery that a number of Indonesian citizens have been positive for the B.1.1.7, B.1.351 and B.1.617 variants. These are now becoming a global concern.
On April 27, the World Health Organization, classified B.1.1.7 and B.1.351 as Variants of Concern (VOC) and B.1.617 as a Variant of Interest (VOI).
On May 4, the European Center for Disease Prevention and Control (E-CDC), also made the same report as WHO, except that it mentioned B.1.1.7+E484K as a VOC.
Also read:
^ Transmission of New Variants Found in Indonesia
^ Three New Variants of SARS-CoV-2 Enter Indonesia
Indonesia reported an E484K mutation in April, which in some countries is known as the "eek mutation".
Now that these new variants have entered our country, it is indeed necessary to take appropriate steps so that their spread can be contained in order to avoid possible spikes in cases, as have happened in other countries. There are at least five steps we can consider taking.
EI and IPC
First, of course, it is necessary to carry out extensive epidemiological investigations (EI) on those who have been found positive for new variants. They must be thoroughly scrutinized to discover who they were in contact with and those contacts must also be examined.
If a contact is negative at the time of examination, it may be because the virus is still in the early incubation period, when it is undetectable. Therefore, it will take some time to observe the contacts. It is also important to check the second layer of contacts, those who physically interacted with those who had direct contact with the patients infected with new variants.
Epidemiological research also seeks to identify where patients first contracted the infection. If the infection was from an Indonesian citizen returning from abroad, it will be easier to contain the virus, but other possible sources of transmission still need to be pursued thoroughly.
Epidemiological investigations should also include whole genome sequencing, as detection of new variants will be necessary for further analysis.
We know that there are at least three types of B.1.617, namely B.1.671.1, B.1.671.2 and B.1.671.3, each of which has different genomic features and must be properly identified in cases taking place in our country.
Second is the need to enhance infection prevention control (IPC) in clinics and hospitals.
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^ Herd Immunity and Covid-19 Metamorphosis
A WHO publication at the end of April noted that widespread transmission of new COVID-19 variants was inversely related to adherence to health protocols and the implementation of IPCs at healthcare facilities, which had been proven effective in reducing the risk of COVID-19 transmission. The decreasing cases, in turn, brought down the number of hospitalizations and deaths from the disease.
For this, three things need to be done, namely the proper implementation of measures on all fronts, knowledge-based and active participation of all health workers and the availability of adequate facilities and infrastructure.
Surveillance and "unusual events"
The third thing that needs to be done is to continue to intensify structurally prepared surveillance activities.
Surveillance must be carried out intently on the epidemiological state of the disease, followed by prompt mitigation responses in accordance with the data observed.
There are at least three aspects of surveillance to adopt. The first is epidemiological surveillance, which seeks to monitor the disease conditions in the community, including fluctuations in the number of cases and deaths, as well as patterns of transmission.
The April 2021 Weekly Situation Report by the WHO SEARO (Southeast Asia Regional Office) found that Indonesia was in a state of community transmission, which urgently called for surveillance on the pattern of transmission in order to contain new variants as well as to curb the pandemic as a whole.
Second, it is necessary to carry out surveillance on the disease’s activity and its symptoms, the possible clinical phenomena and the results of treatments, as well as other aspects. The third aspect is genomic surveillance, which collects data at the molecular level, which is required for more accurate decision making.
The fourth thing to do in order to put new variants in check is ensure consistent virus detection and analysis to anticipate the emergence of what the WHO refers to as “unusual events”.
Also read:
^ Intensifying Covid-19 Genomic Surveillance
^ An Evaluation of the Covid-19 Situation
What is meant here are disease-related incidents that are not commonly encountered, for example, a young person who used to be healthy and fit and complied with 3M health procedures falling ill with COVID-19, or someone who received both vaccinations who had to be admitted to ICU for serious illness, or severe disease clusters occurring in a particular neighborhood, even though the residents had maintained proper ventilation and health protocols.
Unusual events may occur for various reasons, but the probability of new variant infection being the cause necessitates high alertness. Therefore, if unusual events flare up, an in-depth analysis must be made, along with whole genome sequencing and intensive case tracing.
To contain the spread of new variants in our country, the fifth thing we need to do is to follow the 3M protocols strictly, continue 3T activities and increase the number of our citizens vaccinated against COVID-19.
The 3M health protocols are “memakai masker, mencuci tangan, menjaga jarak” (wear a mask, wash your hands, maintain your distance). The distance-keeping protocol also includes the obligation to avoid crowds. Meanwhile, 3T consists of testing, tracing and treatment.
All five points carry two important aspects: to prevent the expansion of the spread of new variants coming from abroad and to avoid the emergence of new variants in our own country. Mutations occur when the virus multiplies.
If a virus replicates, a change in its genes may occur, and this is what is known as a mutation. It happens when transmission continues to spread in a community. If we do not pay close attention to the 3M protocols, transmission in the community may continue to expand and mutations are likely to occur in the country.
Implementing 3M is, of course, very important to prevent us from contracting the lurking new variants. Carrying out intensive tests as part of the 3T procedures are important to detect new cases, and if a new case is classified as an unusual event, it is possibly be related to the new variants we are now highly worried about.
Also read:
^ The Impact of COVID-19 Virus Mutations
^ Virus Mutation Becomes an Obstacle for COVID-19 Vaccinations
The tests must be followed by contact tracing – especially if it is found to be new variant – and therapy to treat the infected. The vaccination program must carry on in order to protect us from COVID-19.
The impacts of new variants and mutations on vaccine efficacy have been discussed widely, but the available vaccines have been helpful so far.
For vaccines currently used in our country, the WHO document on emergency use of listing (EUL) from Feb. 10 mentioned that the Astra Zeneca vaccine had high efficacy against the B.1.1.7 variant but might be less effective for the B.1.351 variant.
In the case of the efficacy dropping, the experts will be able to modify the vaccine in quite a short time. COVID-19 is still ravaging the world with ubiquitous information about its development. We must keep vigilant and active in mitigation measures so that we can deal with the pandemic properly.
Tjandra Yoga Aditama, Director of postgraduate studies at Yarsi University, professor at the University of Indonesia Medical School, Former Director of the Southeast Asia branch of the World Health Organization.
This article was translated by Musthofid.